Introduction
Papillary muscle rupture is one of the rare and potentially life-threatening
complication usually following acute myocardial infarction (AMI). Acute and complete papillary muscle rupture (PMR) results in severe mitral regurgitation rapidly progressing to florid pulmonary edema and cardiogenic shock.1 Without emergent surgical intervention, the mortality is extremely high.
We present an unusual case of 56 years old male who presented with acute
inferior wall myocardial infarction (IWMI) and underwent successful thrombolysis but unfortunately, developed reinfarction 5 days later complicated by acute postero-medial papillary muscle rupture (PPMR) leading to severe acute mitral regurgitation. He was promptly diagnosed and underwent emergent mitral valve replacement.
Key words: COVID - 19, Mitral regurgitation, papillary muscle rupture, Acute myocardial infarction.
CASE PRESENTATION
A 56-year-old smoker not known to have any medical illness presented to us
with progressive chest pain of one-hour duration. Initial electrocardiogram
(ECG) showed inferior leads ST segment elevation (STE) with reciprocal changes in anterior leads (figure 1A) and ST elevation (STE) in right V4R suggestive of acute inferior and right ventricular current of injury. His systemic examination was unremarkable. Peak highly sensitive troponin I assay was >25 (Normal range <0.010) and creatine kinase (CK) level 4764 (Normal range 20 – 200 IU/L).
Based on our institutional protocol in this current covid-19 era, he underwent
thrombolysis with Tenecteplase. His event was complicated with transient
hypotension and heart block which resolved spontaneously. He had successful
thrombolysis with significant resolution of STE (figure 1B) and chest pain free
60 minutes post administration of Tenecteplase.
He was managed conservatively on dual anti-platelet therapy and statin. His
GeneXpert test for SARS COV 2 turned out to be positive without any
significant constitutional symptoms. He was admitted to COVID 19 intensive
care unit with full cardiac monitoring.
A B